Monrovia and Inequities in Health, my New Adventure

Saint Joseph Catholic Hospital Lab- During Malaria Diagnostic Training Course

How did I get here?

As a medical doctor and restless spirit, I have always had the possibility to work and travel extensively during my personal and professional life. Nonetheless, the opportunity to collaborate in projects such as "IGORCARDIA", which aims to support the Liberian Medicines and Health Products Regulatory Authority (LMHRA) in strengthening their capacities for the diagnosis of infectious diseases such as malaria, is not that frequent.

In August 2018, the opportunity appeared when the Juan Ciudad Foundation, in Spain, contacted me to introduce me to ISGlobal researcher Alfredo Mayor, talk about the project, and encourage me to coordinate it from Monrovia, Liberia. In that time, there were lots of personal and professional changes for me... but I embraced the proposal with great enthusiasm given my passion to work with other people and cultures.

My first contact with Monrovia

Anyone who has travelled to the African continent will have felt that everything has a different order from what we know. Within the apparent chaos, there are rules only known by locals. Roberts International Airport in Monrovia, is not an exception.

Anyone who has travelled to the African continent will have felt that everything has a different order from what we know. Within the apparent chaos, there are rules only known by locals

With the fatigue accumulated by the preparations for moving to Liberia, my first challenge was to collect my suitcases and my dogs from an airport where everything was immersed in an apparently chaos. After a long wait, I succeeded! En route to the Saint Joseph’s Catholic Hospital (SJCH) in Congo Town neighbourhood!  

It was not difficult to adapt to my new environment. I was provided with a lovely house within the peaceful compound close to the Hospital, and with an office for the project’s activities. In addition, the brothers of the mission and all the staff gave me a warm welcome and helped me with everything. In this short period, I have passed from ignoring Monrovia’s location on the map to feeling the warmth, rhythm and generosity of their people, which are now part of me.

National Malaria Control Programme (MNCP) Annual Meeting. December 2018, Kakata, Liberia

Daily challenges

After years of civil war and the Ebola epidemic, Monrovia seems to be a city sunk in eternal poverty and destruction. Walking along its streets, I observe its people surviving in buildings blackened by moisture, feeding their children with a handful of rice once a day. However, when discouragement fills my heart, I'm surrounded by a group of children on the beach, amazed by my skinny greyhound, and they start doing pirouettes and dances while laughing. Then they give colour to my day!

After years of civil war and epidemic of Ebola, Monrovia seems to be a city sunk in an eternal poverty and destruction.

Regarding work, carrying out the project tasks is not always easy, either due to the lack of qualified resources in the country and/or the lack of an efficient management. Furthermore, I have to admit that my previous experience coordinating research projects was limited and, taking into consideration that this one was running on its second year, it was very challenging.

The Project: my tasks and activities

As project coordinator located in Monrovia, my activities comprise supporting the Liberian LMHRA institution, increasing the performance of good clinical and laboratory practices in the Saint Joseph´s Catholic Hospital lab, the management of available resources, and ensuring that deadlines and budgets established by the project sponsor – the EDCTP- are achieved.

My main tasks include: assist in the preparation of regulatory frameworks that help improve action protocols; deliver training programs for health personnel who must comply with the protocols for action; help in the creation of work groups; and improve communication and relations between authorities, hospitals, pharmaceutical companies, etc.

One of the activities that has excited me the most has been to organize documentation, posters and presentations to promote gender equality and opportunities in the institution. It was great to listen to the SJCH research team discuss about “gender issues” regarding the Liberian society, where discrimination based on gender identity and sexual orientation is common in personal, family and work contexts, and where there are no data available on the participation of women in science and research.

Presentation "Diagnostic performance of malaria in SJCH (DiagLib)" in National Malaria Control Programme (MNCP). Annual Meeting in Kakata, Liberia

During 2019, we will develop a research study on the diagnosis of malaria, with the aim of comparing the sensitivity of microscopy and rapid tests (RDT) with that of molecular techniques, among patients who attend the SJCH. The availability of rapid diagnostic tests for malaria in recent years has greatly facilitated access to malaria diagnoses. RDTs represented 63% of the diagnostic tests performed in Africa in 2016.

During 2019, we will develop a research study on the diagnosis of malaria, with the aim of comparing the sensitivity of microscopy and rapid tests (RDT) with that of molecular techniques

However, some parasites can suppress the protein dectected by these tests, which could lead to a delay or absence of treatment of infected individuals. With the increase in the number of false negatives by RDT in African countries, WHO has considered the need to monitor malaria parasites that lack the Pfhrp2 gene.

In this context, our research also aims to quantify the presence of Pfhrp2 and Pfhrp3 deletions in P. falciparum isolates in individuals with fever or a history of fever within the last 24 hours, as well as in pregnant women at their first prenatal visit. As secondary objectives, we intend to create a biobank of samples for future research studies.

Almost after three months from my arrival, I am very motivated with the achievements in the project activities, and fascinated with Liberia.

I believe that the best way to contribute against suffering and help close the gaps in health disparities between and within different regions in the world is bringing our best values and knowledge to the field. This is what I am trying to do through IGORCADIA.